NEW: All year, Casey Ross and I have explored how UnitedHealth and NaviHealth have cut off rehab care for Medicare Advantage members. Turns out, there also were secret rules to deny people from getting rehab care in the first place. Our latest: www.statnews.com/2023/12/28/m...
UnitedHealth used secret rules to route rehab care requests from some Medicare Advantage patients for denial, internal documents show.
UnitedHealth Group already owns the largest private health insurance company. Now, it employs or is affiliated with almost 10% of all U.S. physicians. www.statnews.com/2023/11/29/u...
The rapid growth of UnitedHealth’s physician base, including 20,000 doctors in the last year alone, underscores how the company is looking to control more of the health care delivery system.
Medicare’s open enrollment is going on *right now.* It ends Dec. 7. If you’re considering a Medicare Advantage plan, how would it handle skilled nursing care? Could an algorithm kick you out? Ask questions. People have a right to know what they are signing up for.
This also shows just how concerning unregulated AI and predictive technology can be in health care. In this case, algorithms that use things like estimated lengths of stay to influence coverage decisions are inherently flawed and/or biased. www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
Traditional Medicare has a lot of waste. Nursing homes have big $ incentives to keep people as long as possible. This here is the exact opposite: In the pursuit of saving money, MA insurers are denying care to truly sick and frail people. www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
A new federal rule will attempt to address some of these issues. But Medicare also told us, regarding United and NaviHealth, that it “is looking into these allegations and may take necessary enforcement or compliance actions.” www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
All of this at United and NaviHealth has happened under Patrick Conway, a prominent former Medicare official who said this on a podcast a couple years ago: “If [patients] go to a nursing home, how do we get them out as soon as possible?” www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
That’s not all: NaviHealth had talking points to counter “resistance” from nursing homes. The company even wanted case managers to confront patients about why they are appealing payment denials, which patients have every right to do. www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
Clinical case managers had to choose between their job performance and their conscience. “By the end of my time at NaviHealth I realized — I’m not an advocate, I’m just a moneymaker for this company,” one former employee said. www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.
How precisely, you might ask? United’s NaviHealth set a target for 2023 to keep rehab stays of patients in MA plans *within 1%* of the days projected by the algorithm. That’s almost no variance. The algorithm, essentially, became the coverage decision. www.statnews.com/2023/11/14/u...
UnitedHealth executives pressured clinical staff to follow an algorithm to cut off patients’ rehab care, leading to coverage decisions that may violate Medicare regulations.